Cervical Cancer: Single dose of HPV vaccine effective

A single dose of HPV vaccine is as effective as the two or three-dose regimens to protect Indian adolescent girls from cervical cancer, according to a new research that used data from an old study, which was stopped by the central government more than a decade ago.

The findings, the researchers say, may pave the way for introduction of the HPV vaccines in the national immunisation programme of India and other low-income countries as high cost remains the most crucial stumbling block to start HPV inoculations in such programmes.

Cervical cancer is a leading cause of cancer-associated mortality among Indian women with nearly 97,000 new cases and more than 60,000 deaths each year, almost one-fifth of the global burden.

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Studies suggest India can avert more than 24 lakh cases of cervical cancer in the next 50 years and death of thousands of women each year if the government takes up cervical cancer screening and HPV vaccination in a major way.

To check the efficacy of the human papilloma virus (HPV) vaccine, the centre initiated a few trials in the last decade, but all of them were stopped in April 2010 following seven vaccine-unrelated deaths reported in another ongoing HPV vaccination demonstration programme.

By the time, the study was halted, 17,000 plus volunteers were recruited and received at least one dose of the vaccine in one of the studies being carried out by a global team that includes researchers from the International Agency for Research on Cancer, France; Tata Memorial Centre, Mumbai and All India Institute of Medical Sciences, Delhi. The girls were followed up for the last 10 years.

In a study published recently in Lancet Oncology, the team now compared 4,348 volunteers who received three doses with 4,980 persons with two doses and 4,949 who got a single shot. The protection is 93% for the first and second groups and 95% for the third group.

“A systematic 10-year follow-up of a cohort of about 17 000 female participants who received the quadrivalent HPV vaccine at age 10–18 years demonstrated that the protection offered by a single dose of quadrivalent vaccine against persistent infection with HPV16 and HPV18 (the types responsible for nearly 80% of cervical cancers in low- and middle-income countries) was as high as that offered by two doses or three doses of the vaccine,” the IARC said in a statement.

The researchers’ findings could signal a fundamental shift in the accessibility of vaccination against HPV. Under current recommendations, nearly 60% of low- and middle-income countries have not been able to introduce HPV vaccination into their national immunization programmes because of the high cost and the logistical challenges related to delivering two doses of the vaccine.

The two HPV vaccines available in the private markets in India are Ceravix (Rs 3299 for a single dose) and Gardasil (Rs 2,800).

“A recommendation of a single dose would make vaccination programmes against HPV much more affordable and cost-effective for public health decision-makers, potentially enabling those who currently lack access to the vaccine – nearly 90% of adolescent girls in low- and middle-income countries – to be as protected against HPV and its associated cancers as their counterparts in high-income countries,” noted the IARC.

Officials in the Union Health Ministry said that in December 2017, the Indian National Technical Advisory Group on Immunization — an independent advisory group of experts on immunization advising India’s national immunization program — recommended the nationwide introduction of the HPV vaccine to address the high cervical cancer burden in India.

But in March 2021, then Union Minister of State for Health Ashwini Choubey informed the Lok Sabha that the HPV Vaccine has not been recommended by NTAGI for inclusion in the Universal Immunisation Programme.